This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Merz, L. R. Articles by Fraser, V. J. Search for Related Content PubMed PubMed Citation Articles by Merz, L. R. Articles by Fraser, V. J.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, August 2004, p. 2861-2865, Vol. 48, No. 8
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.8.2861-2865.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Effects of an Antibiotic Cycling Program on Antibiotic Prescribing Practices in an Intensive Care Unit

Liana R. Merz,^1,2* David K. Warren,^1,3 Marin H. Kollef,⁴ and Victoria J. Fraser^1,3

Division of Infectious Diseases,¹ Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine,⁴ Saint Louis University School of Public Health,² Barnes Jewish Hospital, St. Louis, Missouri³

Received 20 November 2003/ Returned for modification 5 March 2004/ Accepted 25 April 2004

Various interventions have been proposed to combat the increase of antibiotic resistance and influence antibiotic prescribing practices. A prospective cohort study in a medical intensive care unit was conducted to determine the effect of an antibiotic cycling program on patterns of antibiotic use and to determine patient factors associated with cycling adherence. Four major classes of antibiotics for empirical therapy of suspected gram-negative bacterial infections were rotated at 3- and 4-month intervals. During the study, 1,003 patients received antibiotic therapy with at least one of the study drugs; of the 792 receiving cycle antibiotics during the cycling period, 598 (75.5%) received an on-cycle drug. Compared to the baseline, cycling recommendations increased the use of the target cycle agent: the use of cephalosporins increased during cycle 1 (56 to 64% of total antibiotic days, P < 0.001), fluoroquinolone use increased in cycle 2 (24 to 55%, P < 0.001), carbapenem use increased during cycle 3 (14 to 38%, P < 0.001), and use of extended-spectrum penicillins increased in cycle 4 (5 to 36%, P < 0.001). Overall, 48% of total cycle antibiotic days were compliant with the cycling protocol. On average, 8.8 days per patient were spent receiving on-cycle drugs (range, 1 to 109). Cycle periods that specified carbapenem and fluoroquinolone use had the highest number of off-cycle days (62 and 64%). Predictors of on-cycle antibiotic use were increased severity of illness, as measured by an acute physiology and chronic health evaluation II score, and greater length of intensive care unit stay. In conclusion, the successful implementation of this cycling protocol increased antibiotic heterogeneity over time in the study unit.

---

* Corresponding author. Mailing address: Division of Infectious Diseases, Washington University School of Medicine, Box 8051, 660 S. Euclid Ave., St. Louis, MO 63110. Phone: (314) 454-8231. Fax: (314) 454-5392. E-mail: lmerz{at}im.wustl.edu.

---

Antimicrobial Agents and Chemotherapy, August 2004, p. 2861-2865, Vol. 48, No. 8
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.8.2861-2865.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

This article has been cited by other articles:

• Merz, L. R., Warren, D. K., Kollef, M. H., Fridkin, S. K., Fraser, V. J. (2006). The Impact of an Antibiotic Cycling Program on Empirical Therapy for Gram-Negative Infections. Chest 130: 1672-1678 [Abstract] [Full Text]  
• MacDougall, C., Polk, R. E. (2005). Antimicrobial Stewardship Programs in Health Care Systems. Clin. Microbiol. Rev. 18: 638-656 [Abstract] [Full Text]